A National Center for PTSD Fact Sheet By Kay Jankowski,
Ph.D. and Jessica Hamblen, Ph.D.

Experiencing a disaster, and especially a terrorist event,
is a stressful experience for nearly anybody. Typical responses include
fear, anxiety, sadness, grief, helplessness, and anger. The intensity and
range of feelings that one might experience vary for different reasons.
Personal proximity or exposure to the event and the degree of personal
connection to the victims will affect the way a person reacts to a disaster.
The presence of severe mental illness (SMI) also may affect how a person
experiences a disaster. After a disaster, people with SMI may have an
increased risk for distress, especially posttraumatic stress symptoms.

Are people with SMI more likely to develop
Posttraumatic Stress Disorder (PTSD)?

Multiple studies have shown that people with SMI are more
likely than other people to experience trauma, with over 90% reporting
exposure to at least one traumatic event in their lifetime (e.g., Mueser et
al., 1998; Goodman et al., in press). Moreover, most people with SMI
experience multiple traumatic events (Goodman et al., in press). These
studies have focused primarily on interpersonal trauma, including sexual and
physical assault in childhood and adulthood. While no studies have examined
the specific effects of disaster related stressors, there is accumulating
evidence that, following extremely stressful life events, people with SMI
are more likely to develop PTSD than people without SMI. Studies show that
approximately 30% to 40% of people with SMI currently have PTSD. This is 20
to 30 times the rate for people without SMI (Mueser et al., 1998). The
reason for this increased rate is not fully understood. However, it is
probably due to a combination of factors including increased risk for
victimization (especially interpersonal victimization). People with SMI are
often more exposed to violence and risky situations including living on the
streets and in homeless shelters and engaging in drug abuse. The increased
rate of PTSD in people with SMI also may be due to an increased
vulnerability to stress, which may be related to their primary psychiatric
disorder. In light of their increased risk for PTSD, people with SMI who
experienced significant exposure to the terrorist event on September 11
(e.g., personal injury, death of a loved one, witnessing the explosion) may
be at increased risk for developing PTSD symptoms over time. Even if people
with SMI are able to cope effectively in the immediate aftermath, they may
be more likely than people without SMI to develop posttraumatic symptoms in
the months and years following. Extremely stressful events, such as the
recent terrorist attack, can exacerbate preexisting PTSD symptoms. People
with SMI who have preexisting PTSD in addition to their psychotic disorder
or mood disorder may experience an increase in their PTSD symptoms in much
the same way that other people with PTSD may. This might include (1) having
more upsetting memories and nightmares about past stressful experiences, (2)
increased fear and avoidance of thoughts, feelings, and things related to
the trauma, or (3) increased problems with sleep, concentration, and being
more alert for signs of danger. Given the high rates of PTSD among people
with SMI, there may be a lot of people at risk for such an exacerbation of
posttraumatic symptoms.

What do we know about the effects of disaster and war
on people with severe mental illness?

It is commonly believed that disasters have an increased
negative impact on people with severe mental illness. It is often thought
that people with psychiatric disorders and severe mood disorders are more
vulnerable and less able than others to cope effectively with disaster
related stressors. However, we have found that this may not always be the
case, particularly for those who are in treatment. Several studies have
shown that people with severe psychiatric disorders, whether hospitalized or
outpatient, are not necessarily prone to greater distress following a
disaster.

·1 Psychiatric
patients exposed to the Three Mile Island nuclear accident did not suffer
greater anxiety and depressive episodes than similar psychiatric patients
who lived in an area that was not exposed to the accident (Bromet et al.,
1982).

·3 People with
schizophrenia who were in hospitals in Israel during the Gulf War showed no
greater war-related distress than people from the community who were similar
to the patients in terms of age, gender, education, and marital status (Sternik
et al., 1999). The findings from these studies contrast the results of the
studies reported above that found people with SMI had a strong risk for
developing PTSD, especially following interpersonal traumas. This difference
may be due to the nature of the stressor or to other factors such as sample
size differences or assessment differences. (The studies examining symptom
exacerbation related to disaster and war were quite small and did not assess
specifically for PTSD symptoms.) These discrepancies, however, point to the
need for better information about how people with SMI, both hospitalized and
outpatient, respond to disasters.

How might we meet the needs of people with SMI
following recent events?

·1 Mental-health
providers may want to make additional support and services available if it
appears that a person with SMI is experiencing increased distress.

·2 Given the high
rates of PTSD among this population, routine assessment for PTSD is
recommended. If a person with SMI is experiencing posttraumatic symptoms, it
is especially important to assess for PTSD. Similarly, if a person
experiences an exacerbation of symptoms of their primary psychiatric
disorder, increased problems with functioning, or increased substance use,
it also may be appropriate to assess for PTSD. Despite the high rates of
PTSD in the SMI population, PTSD is not often considered and documented as a
comorbid diagnosis by clinicians.

·3 Effective
treatments for PTSD are available and are presently being developed and
tested by clinicians and people with SMI. Preliminary data suggest that
talking about traumatic events with clinicians familiar with trauma does not
exacerbate SMI symptoms. However, given the early stage of treatment
development, clinicians familiar with trauma may still wish to consult a
trauma specialist when working with an SMI client who is experiencing
symptom exacerbation due to recent trauma.